Complications of Dual Lumen Catheter for Hemodialysis Patients

Chung, Jung Kee; Kang, Han Sung; Suh, Jun Suk; Kwon, Oh Joong; Kim, Sang Joon

Abstract

INTRODUCTION: Central venous catheterization by dual lumen catheter (DLC, Perm Cath ) is used for temporary or permanent vascular access. Although it has many advantages such as rapid insertion, emergent usage or long-term maintenance, there are still clinically important complications associated with insertion procedure and maintaining period. PURPOSE: To define and manage the various kinds of complications is important to avoid repetition of them and to guide for selection of vascular access in long-term hemodialysis patients.
MATERIALS AND METHODS
Between May 1993 and April 1996, we experienced 95 cases of DLC in 88 uremic patients for the following reasons: 12 cases in 12 patients for ARF and 83 cases in 76 patients for ESRD. We used external or internal jugular veins and the method of insertion was percutaneous venipuncture in internal jugular vein (88 cases, Rt.=84, Lt.=4) and venotomy in external jugular vein (7 cases Rt=7). The complications and their therapeutic options were analyzed retrospectively.
RESULTS
Group I complication is associated with insertion procedure, including cardiac arrhythmia (n=65, 68.4%), minor air embolism (n=3, 3.2%), hematoma on puncture site (n=15, 15.8%) and difficult catheterization on multipunctured patients (n=3, 3.2%). Group II complication is associated with long term maintanence use of catheters(mean period=8.3 mos) and includes catheter thrombosis (n=15, 15.8%), inadvertent cuff exposure (n=10, 10.5%) and bacteremia (n=16, 16.6%). The management of complications were as followings. Cardiac arrhythmia occurred during guidewire insertion was completely resolved with wire retraction and clinically detected minor air embolism was recovered spontaneously in all cases. Hematoma on puncture site was controlled by compression in 13 cases and 2 cases were resolved after catheter removal. All of the difficult catheterization was solved with fluoroscopic guide insertion. Most of catheter thrombosis were controlled with urokinase infusion (n=13), but in 2 cases, catheter removal was required. All cases of inadvertent cuff exposure led to ascending infection, among them 6 cases were controlled with catheter removal and the rest of them was controlled with aseptic dressing and antibiotics. Five out of 16 cases (5.3%) with bacteremia were not controlled with antibiotics and resulted in catheter removal.
CONCLUSION
To avoid unfavorable complications such as uncontrolled hematoma or bacteremia, fluoroscopic guide insertion and aseptic handling of exit site is important. And it should be remembered that location of cuff should be far from the exit site (> 2 cm) to avoid inadvertent traction.